Harry Nelson Reveals How To Avoid Medicare Overpayment

Healthcare providers face many concerns in the upcoming year – but none may be more persistent and worrying than Medicare overpayments. In 2013 alone, it’s estimated that nearly $60 billion in Medicare and Medicaid was overpaid, resulting in lost funds that could have supplemented other healthcare services.

Nelson suggested that healthcare providers “refocus [their] current auditing for compliance,” stating that too many of these providers are too focused on maximizing revenue. Instead, Nelson suggests that providers “have to be concerned, not just with getting more money, but also with identifying the problems, preventing them going forward and identifying moneys to be returned.”

Other tips included getting a second opinion on whether a claim is an overpayment, managing the 60-day window for reporting overpayments, looking for patterns of denied claims, and following through with actions on audit results.

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Nelson Hardiman routinely advises providers on Medicare and Medicaid billing and coding compliance matters, both proactively and in response to audits, investigations, and payer recoupment actions or claims.